European Journal of Molecular & Clinical Medicine Association of oxidized LDL, Lipid profile with Psoariasis -A tertiary care center perspective

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European Journal of Molecular & Clinical Medicine
ISSN 2515-8260 Volume 09, Issue 05, 2022
685
Original Research Article
Association of oxidized LDL, Lipid profile
with Psoariasis - A tertiary care center
perspective
Bibek Bhurer Yadav1, Soni Ankita2, SK Bansal3, MPS Sawhney4, NK Singh5,
Busi Karunanad6, Shikhar Ganjoo7 & Kapil Hazarika8
Ph.D. Scholar, Department of Biochemistry, SGT Medical College, Hospital & Research
Institute, Gurugram, Haryana1
Tutor, Department of Biochemistry, SGT Medical College, Hospital & Research Institute,
Gurugram, Haryana2
Professor, Department of Biochemistry, SGT Medical College, Hospital & Research Institute,
Gurugram, Haryana3
Professor and HOD, Department of Dermatology & venereology, SGT Medical College,
Hospital & Research Institute, Gurugram, Haryana4
Tutor, Department of Biochemistry, SGT Medical College, Hospital & Research Institute,
Gurugram, Haryana5
Professor and HOD, Department of Biochemistry, SGT Medical College, Hospital &
Research Institute, Gurugram, Haryana6
Associate Professor, Department of Dermatology & venereology, SGT Medical College,
Hospital & Research Institute, Gurugram, Haryana7
Associate Professor and HOD, Department of Dermatology & Venereology, SGT Medical
College, Hospital & Research Institute, Gurugram, Haryana8
Corresponding Author: Shikhar Ganjoo
Abstract:
Background: Psoriasis is a common, genetically determined, inflammatory and proliferative
dermatological disorder that affects skin, nails & joints characterized by keratinocyte
hyperplasia leading to erythematous oval plaques with adherent silvery scales and has various
systemic involvements. Psoriasis has been associated with an increased risk of
atherosclerosis, including coronary artery disease (CAD) and stroke, for decades. Recent
evidence suggests that oxidation (Ox) of LDL plays an important role in the pathogenesis of
atherosclerosis and cardiovascular diseases. Our study therefore aims to assess ox-LDL and
lipid profile in patients with psoriasis with an objective to observe and report any significant
deviations in the same as compared to healthy controls.
Materials & Methods:
Fifty (50) clinically diagnosed cases of psoriasis and fifty age and gender-matched healthy
controls from the general population were enrolled in the study. Estimation of lipid profile
was assayed by standard photometric methods in auto analyzer ERBA-XL (EM-200) using
commercially available kits and VLDL cholesterol was calculated using the formula adopted
by Friedewald’s and colleagues.12 Estimation of Human Ox-LDL (Oxidized Low Density
Lipoprotein) was done by using ELISA Kit (Elabscience, USA).
Results:
Significant increase in the lipid levels (TC, TG, LDL and VLDL) and significant decrease in
the HDL cholesterol was observed in psoriasis patients when compared with the controls

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ISSN 2515-8260 Volume 09, Issue 05, 2022
686
(p<0.001). Similarly, oxidized low-density lipoprotein (Ox-LDL) was significantly increased
in the patients with psoriasis when compared with the control subjects (p<0.001).
Conclusion:
Our study clearly showed the association of psoriasis with higher OxLDL levels and risk
changes in lipid profile. Similarly, increased levels of (TC, TG, LDL, and VLDL) and
decreased HDL representing an alarming sign for psoriasis towards the progression of
cardiovascular risk was also observed in psoriatic patients. Furthermore, the psoriasis patients
presented significantly higher circulating level of oxLDL combined with the previous studies
supports that the harmful effects of oxLDL, triggers a chronic inflammatory reaction, which
is associated with plaque and thrombosis formation and may lead CVD risk. Therefore, we
suggests early screening of serum lipid profile in psoriatic patients at the time of presentation
as well as follow-up for evaluating risk and treatment of hyperlipidemia to modify and
prevent the progression to future cardiovascular diseases.
Key words: psoriasis oxidized LDL, lipid profile, cardiovascular disease, atherosclerosis.
1. INTRODUCTION
Psoriasis is a chronic inflammatory skin disease affecting 2–3% of the population
worldwide.1, 2 In India, the prevalence of psoriasis varies from 0.44% to 2.8%.3 It commonly
affects individuals in their third or fourth decade with males being affected two times more
common than the females.4
Psoriasis is a multigenic inflammatory disease and more than 20 predisposition genes have
been identified. The role of environmental factors such as infection, drugs, stressful events
and smoking has been suggested. The association of psoriasis with cardiovascular disease
dates back from 1961.5
Psoriasis has been associated with an increased risk of atherosclerosis, including coronary
artery disease (CAD) and stroke, for decades.6-8 Patients with psoriasis have a 5-year shorter
life expectancy, most frequently due to CVD causes.9 Recent evidence suggests that oxidation
(Ox) of LDL plays an important role in the pathogenesis of atherosclerosis and
cardiovascular diseases.10 Oxidized LDL induces atherosclerosis by stimulating monocyte
infiltration, smooth muscle cell migration and proliferation. It contributes to atherothrombosis
by inducing endothelial cell apoptosis, and thus plaque erosion, by impairing the
anticoagulant balance in endothelium, stimulating tissue factor production by smooth muscle
cells, and inducing apoptosis in macrophages.11
Hence, the present study was taken up with the purpose of evaluating the relationship of
oxidized LDL levels and cardiovascular disease risk in patients with psoriasis.
2. MATERIALS & METHODS
This Study was carried out in the Department of Biochemistry and Dermatology of SGT
Medical College, Hospital & Research Institute, Gurugram, Delhi-NCR, India. The Ethical
clearance was obtained from the Institutional Ethical Committee of SGT University,
Gurugram, Delhi-NCR. Written and informed consent was taken from both the subjects prior
to the sample collection.

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687
Fifty (50) clinically diagnosed cases of psoriasis and fifty age and gender-matched healthy
controls from the general population were enrolled in the study.
Clinically diagnosed psoriatic patients without any concomitant cardiovascular disorder with
the age above 18 years were included in the study. Similarly, the subjects with CVD, steroid
and hormonal therapy & drugs affecting lipid levels and renal disorders were excluded from
the study.
Study Design: - Hospital based observational study
Anthropometric parameters including BMI of all the subjects were measured. After 12-14
hours of fasting, 5 ml of venous blood was collected in plain vial taking all aseptic
precautions and serum was separated by centrifuging at 3000 rpm for 10-15 minutes. The
lipid profiles of the subjects were estimated immediately and one aliquot was preserved at –
20°C for the estimation of Oxidized LDL (Ox-LDL) within 1 month of collection of sample.
Estimation of serum total cholesterol, triglycerides, low-density lipoprotein cholesterol
(LDL) and high-density lipoprotein cholesterol (HDL) was assayed by standard photometric
methods in auto analyzer ERBA-XL (EM-200) using commercially available kits and VLDL
cholesterol was calculated using the formula adopted by Friedewald’s and colleagues.12
Estimation of Human Ox-LDL (Oxidized Low Density Lipoprotein) was done by using
ELISA Kit (Elabscience, USA).
Statistical Analysis:
The data obtained was entered into the spreadsheet and the statistical analysis was performed
by using Statistical Package for the Social Sciences (SPSS) version 21.0. Continuous
variables were summarized in the form of means and standard deviations. Graphical data was
presented by bar diagrams. Student’s independent t-test was applied for comparative study of
lipid profile and ox-LDL between Psoriatic patients and the healthy controls. The p-value (p<
0.05) was considered statistically significant for all the parameters.
3. RESULTS
The results of our study suggested that there were disturbances in the lipid profile and
oxidized low-density lipoprotein (Ox-LDL) in psoriasis patients as compared to healthy
controls. The psoriasis patients (n=50) and the healthy controls (n=50) were above the age of
18 years. The mean age of the psoriasis patients was (29.04 ± 6.19) years and for healthy
controls (27.38 ± 4.63) years. The anthropometric parameters like body mass index (BMI)
and the waist-hip ratio (WHR) was significantly raised in psoriatic cases (p<0.001) compared
to controls (Table 1).
Table 1: Comparison of anthropometric measurements between psoriasis patients and
the controls.
Parameters
Cases
(Mean ± SD)
Controls
(Mean ± SD)
t-value
p-value
Age (years)
29.04 ± 6.19
27.38 ± 4.63
1.51
0.13
BMI (Kg/m2)
25.10 ± 3.41
20.60 ± 2.39
7.63
0.001**
WHR
0.86 ± 0.05
0.77 ± 0.04
8.48
0.001**
Our results showed significant increase in the lipid profile (TC, TG, LDL and VLDL) of the
Psoriasis patients (**p<0.001) when compared with healthy controls. However, HDL

European Journal of Molecular & Clinical Medicine
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688
cholesterol was significantly decreased in cases (**p<0.001) when compared with the
controls. Similarly, oxidized low-density lipoprotein (Ox-LDL) was significantly increased in
the patients with psoriasis when compared with the control subjects (p<0.001) (Table 2 &
Figure 1,2).
Table 2: Comparison of lipid profile & oxidized LDL between psoriasis patients and the
controls.
Parameters
Cases
(Mean ± SD)
Controls
(Mean ± SD)
t-value
p-value
TC (mg/dL)
198.23 ± 26.48
141.45 ± 14.75
13.24
0.001**
TG (mg/dL)
161.92 ± 33.99
91.96 ± 21.54
12.29
0.001**
HDL (mg/dL)
36.01 ± 4.45
46.56 ± 4.07
-12.34
0.001**
LDL (mg/dL)
113.42 ± 24.77
82.94 ± 12.55
7.76
0.001**
VLDL (mg/dL)
32.38 ± 6.79
18.39 ± 4.30
12.29
0.001**
Ox-LDL
(ng/mL)
1.55 ± 0.71
0.40 ± 0.32
10.32
0.001**
Figure 1: Graph showing lipid profiles of the psoriasis patients and controls.
0
20
40
60
80
100
120
140
160
180
200
TC TG HDL LDL VLDL
mg/dL
Parameters
Lipid Profile of the subjects
Cases
Controls

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689
Figure 2: Graph showing oxidized low-density lipoprotein (Ox-LDL) of the psoriasis
patients and controls.
4. DISCUSSION
Psoriasis is a common and chronic inflammatory disease of the skin which can be associated
with various comorbidities such as myocardial infarction and stroke.13 additionally, the
prevalence rates of cardiovascular risk factors are increased, including hypertension, diabetes
mellitus, dyslipidemia, obesity, and metabolic syndrome. Consequently, increased mortality
rate and decreased life expectancy have been found in patients with psoriasis, as compared to
the general population.14
Obesity is a significant and growing problem worldwide. Body Mass Index (BMI) is a widely
used tool to measure obesity, where BMI of (18.5–24.9) is considered as normal, BMI of
(25–29.9) as overweight and BMI of ≥30 as obese. Waist circumference may be a more
accurate measurement of abdominal obesity and its measurements, >40 inches (102 cm) in
men and >35 inches (88 cm) in women increases the risk of morbidity from conditions
associated with obesity.15
In the present study, body mass index (BMI) and the waist-hip ratio (WHR) were
significantly raised in psoriatic cases (p<0.001) compared to controls. Our results were
similar to the previous findings.16-21 However, there were contradictory findings by previous
authors who did not find significant differences in BMI between psoriasis patients and the
control groups.22-26
Abnormalities in lipid metabolism play an important role in the pathogenesis of psoriasis.27
recently; the association of psoriasis with metabolic syndrome has been extensively
established that contains a variety of cardiovascular risk factors, such as atherosclerosis,
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
Cases Controls
ng/mL
Ox-LDL of psoriasis cases and controls

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dyslipidemia, and obesity.17, 28, 29 In the present study, dyslipidemia was observed
characterized by significant increase in the levels of lipid profile (TC, TG, LDL and VLDL)
in psoriasis patients (p<0.001) and significant decrease in the HDL cholesterol level
((p<0.001) when compared to controls. Our findings were consistent with the previous
studies.26, 30-32 On the contrary, Jones SM et al. (2000)33, Pietrzak A et al. (2002)22, found
significantly lower total cholesterol and LDL cholesterol than their controls.
HDL cholesterols has anti-oxidative, anti-inflammatory, anti-apoptotic and anti-thrombotic
functions hence its importance goes much beyond reverse cholesterol transport and are of
pivotal importance in atherosclerosis.34 Disturbances in HDL level may play a role in
atherogenesis and vascular disease associated with psoriasis.35
Oxidized LDL is of great importance in the development and progression of atherosclerosis
including activation of monocytes, leading to their infiltration and smooth muscle cell
proliferation.36 Atherosclerosis is initiated by the accumulation of oxidatively modified LDL
within plaques, which release ROS. Accumulation of ox-LDL in psoriatic skin also plays a
role in the immune inflammatory events resulting in progressive skin damage.24 During the
initial stage of atherosclerosis ox-LDL can activate endothelial cells through the lectin-like
oxidized low-density lipoprotein receptor-1 (LOX-1) leading to an up-regulation of many
different signaling pathways including the CD40/CD40L pathway.37, 38
In our study, Ox-LDL was significantly increased in the patients with psoriasis when
compared with the control subjects (p<0.001). Similar results were found by Coimbra S et al.
(2009)19, Coimbra S et al. (2010)20, Sunitha S et al. (2016)39, Asha K et al. (2017)40 and
Pietrzak A et al. (2019)26. This is in contrast to other studies conducted by Gerdes S et al.
(2014)41 and Sorokin AV et al. (2018)42 who were not able to show differences in the serum
levels of ox-LDL in the patient groups.
5. CONCLUSION
In the present study, our data clearly showed that psoriasis is associated with higher OxLDL
levels and risk changes in lipid profile. Thus, this profile seems to be independent of the
severity and duration of psoriasis.
Similarly, significantly increased levels of (TC, TG, LDL, and VLDL) and decreased HDL is
an alarming sign that psoriasis is progressing towards cardiovascular risk and may be
responsible for higher prevalence of cardiovascular accident in psoriatic patients.
Furthermore, the psoriasis patients presented significantly higher circulating level of oxLDL
combined with the previous studies supports that the harmful effects of oxLDL, triggers a
chronic inflammatory reaction, which is associated with plaque and thrombosis formation and
may lead CVD risk.
Therefore, we suggests early screening of serum lipid profile in psoriatic patients at the time
of presentation as well as follow-up for evaluating risk and treatment of hyperlipidemia to
modify and prevent the progression to future cardiovascular diseases.
Acknowledgement:
Conflict of interests: Nil.

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